What is risk?

Published on 24/05/2015 by admin

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Chapter 2 What is risk?

It must be understood that risk cannot be eliminated entirely. To do so would be to move from risk management to certainty management, which is not possible within clinical practice.¹

Risk is in everything that people do. Driving to work entails taking risk although often this is not consciously considered. Choosing a car or a house can be a very risky business. Buying a house requires care and assessment of all sorts of possibilities before the cheque is signed.

If there were no potential benefits to be had, people would never take any risks. For example, everyone takes risks getting to work each day and yet if they didn’t take those risks, nothing would ever get done.

There will always be a degree of uncertainty about what might happen when risks are taken. For those risks that are taken every day, the likelihood of something going wrong is known to be quite low so anxiety is low. However, when it is a new risk or if the possible outcome is very severe, anxiety levels can be substantially higher.

The opposite of risk — certainty or complete safety — is something which can never be achieved in a mental health setting so clinicians will always find themselves needing to work alongside patients with a certain degree of risk and its accompanying anxiety.

For risks such as crossing the road or driving a car along the motorway, there is no need to think about how to manage the situation effectively as it has been done a thousand times before. Managing risk in a mental health setting is no different. It is primarily an exercise in decision-making. The task is to try and prevent adverse outcomes whilst maximising the likelihood of a good outcome (risks versus benefits). The process of decision-making can vary from an intuitive decision made on the run using cognitive shortcuts (heuristics; see glossary) to a deliberate, carefully considered plan made over several days or even weeks. There are advantages and disadvantages to each process which will be explored throughout the book. With regular practice, clinicians can learn to manage risky situations effectively and minimise the risk of adverse outcomes whilst continuing to treat and care for patients.

With a clear structure to risk management, decision-making can be documented in the notes and information shared with patients and other staff. There will be less need to rely on gut feelings and intuition. Staff will be less anxious about what they are doing and will have greater potential for flexibility.

With the increasing accountability expected today, it has become more necessary to ‘document our thinking for the record’.² Having a good structure simplifies this process substantially.

BOX 2.1 SUMMARY OF LEARNING POINTS

• If there were no potential benefits, clinicians would not need to take risks.

• Decision-making can be done quickly using cognitive shortcuts (heuristics) or be made more slowly in a deliberate and carefully weighed fashion.

• Having a clear structure to the assessment and management of risk makes practice transparent and improves communication.

Definition of risk

Dictionary definitions of risk vary, but commonly used definitions in mental health settings are:

Risk: the likelihood of an adverse event or outcome.

Risk: the possibility of incurring misfortune or loss.

Compare these definitions with the definition of chance:

Chance: the unknown and unpredictable element that causes an event to result in a certain way rather than another.

The word ‘chance’ is often confused with risk but it has a slightly different definition in which the outcome may be favourable.

There are three major components to any definition of risk:

2. outcome: it needs to be an adverse event

3. time: how imminent is the event?

The likelihood of an event can also be considered in terms of probability, possibility, prediction and so forth.

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